BRIDGEWAY RECOVERY CENTER, LLC (NPI# 1821610452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821610452 |
| Entity Type | Organization |
| Organization Name | BRIDGEWAY RECOVERY CENTER, LLC |
| Practice Address |
1102 Williams St Valdosta GA 31601-4041 |
| Practice Telephone | 8503487225 |
| Practice Fax Number | 2295066877 |
| Mailing Telephone | 8503487225 |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |
| Authorized Official Name | KERMIT L ELLIOTT JR. (CEO) |
| Authorized Official Telephone | 8503487225 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
1102 WILLIAMS ST |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31601-4041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437700838 | Tristan Carlos Garcia | Specialist/Technologist | 605 West Mary Street, Valdosta, GA 31601 | 2019-09-26 |
| 1508332438 | Euniqua Lashay Williams | Contractor | 812 Lausanne Drive, Valdosta, GA 31601 | 2018-10-18 |
| 1457847634 | Valencia Meshay Johnson | Contractor | 1211 North Oak Street, Valdosta, GA 31601 | 2018-07-10 |
| 1376038042 | Restoration Care Services, LLC | Home Health | 704 Lake Park Road, Valdosta, GA 31601 | 2018-06-26 |
| 1609373133 | Ikea Sharnay Calhoun | Contractor | 1710 Dedo Drive, Valdosta, GA 31601 | 2018-04-11 |
| 1174049431 | Alexious Denson | Contractor | 900 Blanton St., Apt A16, Valdosta, GA 31601 | 2017-08-18 |
| 1578012258 | Clarissa Yolanda Alderman | Counselor | 4107 N Forrest Run Circle, Valdosta, GA 31601 | 2016-09-23 |
| 1225322613 | Andrea J. Ramirez | Counselor | 1301 Melody Ln Ste B, Valdosta, GA 31601 | 2011-06-03 |
| 1316248560 | L&r Personal Care Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 14 Sharper Circle, Valdosta, GU 31601 | 2010-11-04 |
| 1902121809 | Grace Healthcare Services Inc | Respite Care | 1010 Slater Street, Valdosta, GA 31601 | 2010-04-02 |
| Find all providers in zip 31601 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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|---|---|---|---|---|
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| 1366891947 | Valdosta Healthcare Club | Clinic/Center | 4370 Kings Way Ste C, Valdosta, GA 31602-6905 | 2016-06-06 |
| 1588803720 | Resolution Family Weight Loss and Wellness Center | Clinic/Center | 2231 Bemiss Rd, B, Valdosta, GA 31602-4812 | 2009-02-11 |
| 1952729980 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 1550 Commerce Dr, Valdosta, GA 31601-1206 | 2014-04-07 |
| 1447695085 | Sgmp Southland LLC | Clinic/Center | 201 Woodrow Wilson Dr, Valdosta, GA 31602-2538 | 2013-05-09 |
| 1730354739 | Airport Clinic Inc | Clinic/Center | 704 Gil Harbin Industrial Blvd, Valdosta, GA 31601-6513 | 2008-04-30 |
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| 1134741580 | Knowles Exams & More | Clinic/Center | 123 Glyndale Dr Ste 107, Brunswick, GA 31520-1404 | 2020-05-08 |
| 1447886320 | Momentum Rehab & Therapy | Clinic/Center | 5349 Snapfinger Woods Dr, Decatur, GA 30035-4028 | 2020-03-23 |
| 1073146759 | Transitional Care Clinic LLC | Clinic/Center | 2084 Newnan Crossing Blvd E Ste 300, Newnan, GA 30265-2561 | 2020-02-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.